Health care providers have a great deal of influence on parents with regard to vaccination of children. The characteristics of a child's health care provider may be more influential on vaccination decisions than the characteristics of the child or family. School personnel also have influence on the decisions of parents to vaccinate their children as the vaccine related knowledge, attitudes and beliefs of school personnel have been associated with parental decisions to vaccinate. Bioterriorism issues have heightened our awareness of vaccine misperceptions among the public and health care providers. Perception of immunization to prevent biological threats may differ from perceptions of vaccines targeting naturally occurring diseases. Providers and the general public may be more willing to accept rare, serious vaccine associated adverse events to prevent diseases known to cause significant morbidity and mortality than for vaccines to prevent diseases that are of theoretical risk. The study's specific aims are to: (1) Conduct a controlled evaluation of two interventions for school nurses/personnel and parents considering or requesting an exemption regarding state immunization requirements, vaccine preventable diseases, vaccine safety and efficacy, and vaccine related misconceptions; (2) Compare the knowledge, attitudes, beliefs and practices regarding vaccines of health care providers for children who are not fully vaccinated (exempt) with health care providers for fully vaccinated children; and (3) Determine if vaccine related knowledge, attitudes and beliefs of health care providers are associated with vaccine related knowledge, attitudes and beliefs of parents. In order to address these aims, an intervention study will be conducted in Washington State of school personnel and parents considering or requesting a school immunization exemption. Additionally, a survey will be conducted of 1,000 health care providers identified by the parents of fully vaccinated and non-vaccinated (exempt) children. Health care provider surveys will be linked to parental surveys that have already been completed. Throughout this grant I will improve my training in the theories, application and statistical methods of behavioral science, risk assessment and risk communication. I will be guided by my primary mentor, Dr. Neal Halsey, from Johns Hopkins University Bloomberg School of Public Health, and a Advisory Council of mentors, including Professor Teret and Drs. Roter, Curbow, Latkin, and Celentano from the Johns Hopkins Bloomberg School of Public Health, Dr. Bostrom from Georgia Institute of Technology, Dr. Fischhoff from Carnegie Mellon University, and Dr. Marcuse from Children's Hospital in Seattle and the University of Washington. These mentors will work with me through a combination of coursework, directed readings and supervised research over the course of this award.